Names of Pupils Should Not Appear on Forms

C-ABA FBA Form

Preliminary Functional Behaviour Assessment

NAMES OF PUPILS SHOULD NOT APPEAR ON FORMS

Gender: Age: Class:
Relevant Diagnosis or Health Issues/Concerns: (sleep, diet, illness)
How is the pupil coping with the curriculum? (Discuss prompt use as needed)
Pupil’s strengths:
Communication: (Questions to consider)
Is the pupil verbal/non verbal?
How is the pupil currently using his/her language? (e.g. idiosyncratic language, echolalia etc.)
Does he/she have a functional communication system in place?
Level of functional language? How does the pupil currently express his/her needs and wants?
Level of expressive Vs receptive language? Level of prompts provided Vs spontaneous?
Social Skills:
Self-Help Skills:
1) Describe/ define the behaviour:
2) What behaviour would you like to see instead?
3) How long has the behaviour being going on?
4) How often does the behaviour occur?
5) How long does the behaviour last for?
6) When / where does the behaviour occur? (time of day, location)
7) When / where is the behaviour least likely to occur?
8) Does the behaviour occur if the pupil is alone?
9) Are there any obvious triggers for the behaviour?
(e.g. noise, person, crowd, delay in the start of preferred indicated activity, ending a preferred activity, waiting, not getting own way etc.)
10) Are there any known setting events related to the behaviour?
(e.g. sudden cancellation of events, hunger, tiredness, change in routine, return to school after weekends/ school holidays, events at home, illness)
11) What interventions have you tried already? How have they worked for you?
12) What do you do when this behaviour happens?
13) What do the other adults in the room do when this behaviour happens?
14) Is this what you do every time the behaviour happens?
15) What do the other pupils do when this behaviour happens?
16) What does the pupil gain from the behaviour?
17) What helps to calm the pupil? How long does this take?
18) What do you think your pupil is saying / communicating through the behaviour?
I want …attention / I want an object… / I want to avoid …. / I want stimulation.. (self stimulatory)
19) What activities, games, toys or other does the pupil enjoy?
20) Does the behaviour happen at home?
21) Any other information that may be relevant?

Other:

Was the collection of ABC data reviewed Yes No N/A

Does additional information on setting events need to be collected? Yes No N/A

Does reinforcer sampling need to be conducted? Yes No N/A

List type of data recording that will be collected: